ECHOCARDIOLOGY SELE C TED PAPERS

PRESENTED DURING THE FOURTH SYMPOSIUM AT ERASMUS UNIVERSITY, ROTTERDAM , JUNE 24-26 , 1981

INTERUNIVERSITY INSTITUTE OF CARDIOLOGY , AMSTERDAM

DEVELOPMENTS IN CARDIOVASCULAR MEDICINE

VOLUME 13

Other volumes in this series,'

1. Lancee CT, ed: Echocardiology. 1979. ISBN 90-247-2209-8. 2. Baan J, Amtzenius AC, Yellin EL, eds: Cardiac dynamics. 1980.

ISBN 90-247-2212-8. 3. Thalen HJT, Meere CC, eds: Fundamentals of cardiac pacing.

1979. ISBN 90-247-2245-4. 4. Kulbertus HE, Wellens HJJ, eds: Sudden death. 1980. ISBN

90-247-2290-X. 5. Dreifus LS, Brest AN, eds: Clinical applications of cardiovascular

drugs. 1980. ISBN 90-247-2295-0. 6. Spencer MP, Reid JM, eds: Cerebrovascular evaluation with

Doppler ultrasound. 1981. ISBN 90-247-2384-1. 7. Zipes DP, Bailey JC, Elharrar V, eds: The slow inward current

and cardiac arrhythmias. 1980. ISBN 90-247-2380-9. 8. Kesteloot H, Joossens JV, eds: Epidemiology of arterial blood

pressure. 1980. ISBN 90-247-2386-8. 9. Wackers FJT, ed: Thallium-201 and technetium-99M-pyrophos­

phate myocardial imaging in the coronary care unit. 1980. ISBN 90-247-2396-5.

10. Maseri A, Marchesi C, Chierchia S, Trivella MG, eds: Coronary care units. 1981. ISBN 90-247-2456-2.

11. Morganroth J, Moore EN, Dreifus LS, Michelson EL, eds: The evaluation of new antiarrhythmic drugs. ISBN 90-247-2474-0.

12. Alboni P: Intraventricular conduction disturbances. ISBN 90-247-2483-X.

series ISBN 90-247-2336-1

ECHOCARDIOLOGY

edited by

HANS RIJSTERBORGH

Thoraxcenter, Erasmus University, Rotterdam Interuniversity Institute of Cardiology, Amsterdam

II 1981

MAR TINUS NIJHOFF PUBLISHERS

THE HAGUE / BOSTON / LONDON

Distributors:

for the United States and Canada

Kluwer Boston, Inc. 190 Old Derby Street Hingham, MA 02043 USA

for all other countries

Kluwer Academic Publishers Group Distribution Center P.O. Box 322 3300 AH Dordrecht The Netherlands

Library of Congress Cataloging in Publication Data

Main entry under title:

Echocardiology.

(Developments in cardiovascular medicine; v. 13) Proceedings of the 4th Symposium on Echocardiology. Includes indexes. 1. Ultrasonic cardiography-Congresses.

I. Rijsterborgh, Hans. II. Symposium on Echocardiology (4th: 1981: Erasmus University, Rotterdam) III. Series. RC683.5.U5E25 1981 616.1'207543 81-38415

ISBN-13: 978-94-009-8301-4 e-ISBN-13: 978-94-009-8299-4 DOl: 10.1007/978-94-009-8299-4

Copyright © 1981 by Martinus NijhofJ Publishers. The Hague. S(~ftcover reprint of the hardcover 1st edition 1981

All rights reserved. No part of this publication may be reproduced. stored in a retrieval system. or transmitted in any form or by any means. mechanical. photocopying. recording. or otherwise. without the prior written permission of the publisher. Martinus NijhofJ Publishers. P.o. Box 566. 2501 CN The Hague, The Netherlands.

FOREWORD

This symposium is the fourth of a series of scientific meetings in the field of echocardiology, held at the Erasmus University, Rotterdam.* The series was initiated by Klaas Born, who organized the first two meetings, and was continued by Charles Lancee. These previous symposia met with great success.

These proceedings comprise most of the invited lectures and free commu­nications which had their' live performance' during the 4th Symposium on Echocardiology.

We decided, again, to maintain one ofthe most striking features of the last meetings: having the proceedings available at the time of the meeting. As a consequence, the authors-to-be were confronted with a very tight schedule. The editing time was also limited and therefore neither terminology nor units have been completely standardized. However, as a result, these proceedings do reflect the 'state of the art' in echocardiology.

This is not a textbook on echocardiology, but cardiologists and techni­cians, with experience in the field of echocardiology, will certainly appreciate the educational features of this book.

This symposium was organized in association with Interuniversity Institute of Cardiology, Amsterdam, the Netherlands. Dutch Society of Ultrasound in Medicine and Biology Dutch Heart Foundation, The Hague, the Netherlands European Society of Cardiology

Financial support was given by Interuniversity Institute of Cardiology, Amsterdam, the Netherlands University-fund Rotterdam Foundation, Rotterdam, the Netherlands Dutch Heart Foundation, The Hague, the Netherlands.

Rotterdam, June 1981 HANS RIJSTERBORGH

* The second symposium has been published as: Born N, ed: Echocardiology. Martinus Nijhoff Publishers, The Hague/Boston/London: 1977. The third symposium has been published as: Lancee CT, ed: Echocardiology. Martinus Nijhoff Publishers, The Hague/Boston/London: 1979.

ACKNOWLEDGEMENTS

A book of this size is naturally the work of a large team. First of all, I wish to express my gratitude to, and my admiration of, all the lecturers who provided me with their carefully prepared manuscripts, in some cases at very short notice. Without their excellent cooperation this book would not exist.

I am especially indebted to Mary Rose Hoare, who contributed heavily to the editing and correcting of the material. Without her critical support, this book would have looked quite different.

My colleagues of the organizing committee, Klaas Born, Jos Roelandt, Charles Lancee and Paul Hugenholtz were always available for assistance and advice, for which I am very grateful.

Furthermore, I have to thank our secretaries Corrie de Bruijn, Ineke van Lieshout and Ria Willemstein who cheerfully invested many hours in the preparation of this book.

Thanks are also due to Hans Eggink who spent hours on the preparation of the very long list of contributors and to Egbert Bos and Paul Voogd who helped in reading manuscripts and in explaining the finer points of pediatric cardiology to me.

Finally, I would like to pay a special tribute to Martinus Nijhoff Publishers, whose achievement, the publication of a book of this type within a period of six months, should be in the Guinness Book of Records.

HANS RIJSTERBORGH

CONTENTS

Forewurd

Acknowledgements

Contributors

I. ECHOCARDIOLOGY IN ADULTS

A. GENERAL APPLICA nONS

1. D.G. GIBSON / Echocardiography as the diagnostic investigation

v

VII

XV

before cardiac surgery 3 2. DJ. SAHN / Intraoperative applications of two-dimensional and

contrast two-dimensional echocardiography for evaluation of con­genital, acquired and coronary heart disease in open-chested humans during cardiac surgery 9

3. R. ERBEL, P. SCHWEIZER, P. BARDOS, 1. MEYER, S. MINALE, BJ. MESSMER, and S. EFFERT / Long-term control ofleft ventricu­lar function after aortocoronary bypass surgery by two-dimensional echocardiography 25

4. W.e. JANSEN, B. NIEHUES, V. HOMBACH, E. SCHERER, D.W. BEHRENBECK, and H.H. HILGER / Evaluation of the St. Jude Medical valve prosthesis in the mitral position 33

5. GJ. LEECH, T.E. GUINEY, MJ. DAVIES, and DJ. PARKER / Echocardiography of the aortic valve 39

6. P. SCHWEIZER, R. ERBEL, H. LAM BERTZ, and S. EFFERT / Two­dimensional suprasternal echocardiography in diseases of the tho-racic aorta 55

7. H. FEIGENBAUM / Visualization of the coronary arteries by two-dimensional echocardiography 61

8. M.D. EZEKOWITZ, D.A. WILSON, E.O. SMITH, PJ. KANALY, and D.E. PARKER / Two-dimensional echo cardiography and Indium-111 platelet scintigraphy in the diagnosis of left ventricular throm-bi - competitive or complementary 73

x

B. ApPLICATIONS IN LEFT VENTRICULAR FUNCTION ANALYSIS

9. J.L. WEISS / Quantitative two-dimensional echocardiography III

coronary artery disease 83 10. MJ. MONAGHAN, K. DALY, G. JACKSON, and D.E. JEWITT / Early

detection of acute myocardial ischaemia and infarction by cross-sectional echocardiography 93

11. c.A. VISSER, L.R. VAN DER WIEKEN, G. KAN, and D. DURRER / Dynamic exercise cross-sectional echocardiography: comparison with coronary arteriography and radionuclide angiography 99

12. R B. STAMM, B. CARABELLO, D. WATSON, G. TAYLOR, G. BELLER, and R.P. MARTIN / Comparison of regional wall motion deter­mined by two-dimensional echocardiography, radionuclide angio-graphy and left ventriculography 103

13. A. DIST ANTE, A. L' ABBATE, D. Rov AI, C. PALOMBA, and A. MASERI / Detection of transient myocardial ischemia by M-mode echocardiography in man 109

14. A. BLOCH, Ch. MAYOR, and G. MERIER / Echocardiographic differential diagnosis of congestive cardiomyopathy and advanced coronary heart disease 117

15. J.A. WERNER, S.M. SPECK, H.L. GREENE, c.L. JANKO, and B.W. GROSS / Does echocardiography aid in the management of acute myocardial infarction? 123

16. O.L. BASTIAANS, RS. MELTZER, J. MCGHIE, P.W. VERBEEK, and J. ROELANDT / Quantification from two-dimensional echocardio-graphic images 131

17. N.B. SCHILLER, T.A. PORTS, and N.H. SILVERMAN / Quantitative analysis of the adult left heart by echocardiography 145

18. R. lENNI, A. VI ELI, l. TURINA, M. ANLIKER, and H.P. KRA YENBUEHL / Determination of ventricular volume from apical orthogonal two-dimensional echocardiograms 163

19. D.M. DAVIDSON, RL. Popp, W.L. HASKELL, P.D. WOOD, S. BLAIR, and P. Ho / Echocardiographic changes during a one­year exercise program in previously sedentary normal middle-aged men 167

20. J.R DAWSON and G.c. SUTTON / Prediction of coronary artery disease in hypertension 171

21. PJ. VOOGD, 1. SCHICHT, P.CJ. VAN BREDA VRIESMAN, and L.K. MONSJOU / Left ventricular hypertrophy in patients on chronic hemodialysis 179

22. P. HANRA TH, P. KREMER, and B.A. LANGENSTEIN / Determination of quantitative left ventricular function by M-mode echocardiogra-phy together with other noninvasive parameters 189

23. J. COSYNS, D. DELATTE, D. RAPHAEL, and Ch. VAN EYLL / Mean velocity of fiber shortening as linear function of heart rate and wall

XI

stress: noninvasive measurements 199 24. P. KREMER, M. MATSUMOTO, B. LANGENSTEIN, and P. HANRATH /

The evaluation of left ventricular performance by simultaneous recording of two-dimensional echocardiogram and left ventricular pressure

C. ApPLICA nONS OF CONTRAST ECHOCARDIOLOGY AND DOPPLER ECHO­CARDIOLOGY

25. RL. POPP, and Ch. R TUCKER / Structure identification by

205

contrast echocardiography 211 26. J. ROELANDT, RS. MELTZER, and P.W. ~ERRUYS / Contrast

echocardiography of the left ventricle 219 27. RS. MELTZER, P.W. SERRUYS, and J. ROELANDT / Contrast

echocardiography in valvular regurgitation 233 28. A.N. DEMARIA, W. BOMMER, J. RAZOR, G. TICKNER, and

D.T. MASON / Determination of cardiac output by two-dimen-sional contrast echocardiography 245

29. T. BONZEL, D. FASSBENDER, N. BOGUNOVIC, G. TRIEB, and U. GLEICH MANN / Analysis of right heart blood flow from contrast patterns on the echocardiogram 255

30. SJ. GOLDBERG, L.M. VALDES-CRUZ, Y. CARNAHAN, H. HOENECKE, H.D. ALLEN, and DJ. SAHN / Comparison of microbubble detection by M-mode echocardiography and two-dimensional echo i Doppler techniques 263

31. R.S. RENEMAN, A. HOEKS, C. RUISSEN, and F. SMEETS / Pulsed-Doppler systems and cardiovascular disease 269

32. D. KALMANSON, C. VEYRAT, G. ABITBOL, and M. FARlON / Doppler echocardiography and valvular r~gurgitation, with special emphasis on mitral insufficiency: advantages of two-dimensional echocardiography with real-time spectral analysis 279

33. C. VEYRAT, D. KALMANSON, M. FARlON, J.P. GUICHARD, D. SAINTE-BEUVE, and G. ABITBOL / Combined pulsed-Doppler echocardiography for the investigation of valvular heart diseases: one-dimensional versus two-dimensional approach 291

34. T. SKllERPE and L. HATLE / Diagnosis and assessment of tricuspid regurgitation with Doppler ultrasound 299

XII

II. PEDIATRIC ECHOCARDIOLOGY

A. GENERAL APPLICATIONS

35. A.E. BECKER and WJ. GUSSENHOVEN / Segmental analysis of congenital heart disease. A correlation between pathology and echocardiography 307

36. WJ. GUSSENHOVEN and A.E. BECKER / Erroneous interpretation of echocardiograms in congenital cardiac abnormalities consequent to anatomic variability 323

37. N.H. SILVERMAN, A.R. SNIDER, and N.B. SCHILLER / Quantitative assessment of congenital heart disease by two-dimensional echo-cardiography 333

38. G.R. SUTHERLAND, MJ. GODMAN, R.H. ANDERSON, and S. HUNTER / The spectrum of atrioventricular valve atresia: A two-dimensional echocardiographic/pathological correlation 345

39. J.F. SMALLHORN, G. TOMMASINI, and FJ. MACARTNEY / The detection and assessment of straddling and overriding atrioventri-cular valves by two-dimensional echocardiography 355

40. A. MAG HERIN I and G. AZZOLINA / Two-dimensional echocardio­graphy for pre- and post-surgical evaluation of atrioventricular canal malformations 363

B. ApPLICATIONS OF CONTRAST ECHOCARDIOLOGY AND DOPPLER ECHO­CARDIOLOGY

4l. S. HUNTER and G.R. SUTHERLAND / Contrast M-mode echocar-diography, the suprasternal notch approach 373

42. EJ. MEIJBOOM, M.H. GEWITZ, D.C. WOOD, and W.W. Fox / Evaluation of right-to-Ieft intracardiac shunting in newborns by contrast echocardiography 383

43. G. LUTFALLA, M. TOUSSAINT, Fl. DE VERNEJOUL, and F. GUERIN / Contrast echocardiography in univentricular hearts 395

44. lG. STEVENSON, I. KAwABORI, and M.A. BRANDESTINI / A twen­ty-month experience comparing conventional pulsed-Doppler echocardiography and color-coded digital multigate Doppler, for: detection of atrioventricular valve regurgitation, and its severity 399

45. O. DANIELS, lC.W. HOPMAN, G.B.A. STOELINGA, HJ. BUSCH, and P.G.M. PEER / A combined Doppler echocardiographic investiga­tion in premature infants with and without respiratory distress syndrome 409

46. J.W. WLADIMIROFF, J. MCGHIE, and R. VOSTERS / Fetal cardiac activity 417

XIII

47. D.A. REDEL and M. HANSMANN / Fetal obstruction of the foramen ovale detected by two-dimensional Doppler echocardiography 425

III. TECHNOLOGICAL ASPECTS OF ECHOCARDIOLOGY

48. C.T. LANCEE and J.A. BLOM / M-mode scanning with automatic gain control 433

49. R. FEHR / Pulsed-Doppler with real-time Fourier transform 443 50. W.E. MORITZ, D.K. MEDEMA, D. MCCABE, and A.S. PEARLMAN /

Three-dimensional imaging and volume determination using a series of two-dimensional ultrasonic scans 449

51. P.N.T. WELLS / Present status of tissue identification 455 52. E.G. TICKNER / Precision microbubbles for right side intracardiac

pressure and flow measurements 461

Index 473

CONTRIBUTORS

Abbate, A L'., CNR Clinical Physiology Institute and University of Pisa, Pisa, Italy.

Abitbol, G., Dept, of Cardiology, Fondation A de Rothschild, Paris, France.

Allen, H.D., University of Arizona, Tucson, Arizona, USA Anderson, R.H., Cardiothoracic Institute, Brompton Hospital, London,

England. Anliker, M., Institute for Biomedical Engineering, University and ETH,

Zurich, Switzerland. Azzolina, G., Tuscan Heart and Chest Center, Florence, Italy. Bardos, P., Dept. of Cardiovas. Surgery, Rheinisch-Westfalische Technische

Hochschule, Aachen, FRG. Bastiaans, O.L., University of Technology, Delft, The Netherlands. Becker, AE., Dept. of Pathology, University of Amsterdam, Wilhelmina

Gasthuis, Amsterdam, The Netherlands. Behrenbeck, D.W., Med. Clinic and Policlinic, Dept. of Cardiology, Univer-

sity of Cologne, Cologne, FRG. Beller, G., University of Virginia, Charlottesville, Virginia, USA Blair, S., Stanford University, Stanford, California, USA Bloch, A, Cardiac Center, University Hospital, Geneva, Switzerland. Blom, 1.A, Dept. of Obstetrics, Erasmus University, Rotterdam, The

Netherlands. Bogunovic, N., Gollwitzer Meier Institut, Bad Oeynhausen, FRG. Bommer, W., Sect. of Cardiovascular Medicine, School of Medicine, Davis,

California, USA Bonzel, T., Abt. Kardiologie, Medizinische Universitatsklinik, Freiburg,

FRG. Brandestini, M.A, University of Washington, Seattle, Washington, USA Breda Vriesman, P.C.J. van, Dept. of Pathology, University of Leiden,

Leiden, The Netherlands. Busch, H.J., Dept. of Pediatric Cardiology, University of Nijmegen,

Nijmegen, The Netherlands. Carabello, B., University of Virginia, Charlottesville, Virginia, USA Carnahan, Y., University of Arizona, Tucson, Arizona, USA

XVI

Cosyns, J., Cliniques Universitaires Saint-Luc, Brussels, Belgium. Daly, K., Cardiac Dept. King's College Hospital, London, England. Daniels, 0., Dept. of Pediatric Cardiology, University of Nijmegen,

Nijmegen, The Netherlands. Davidson, D.M., Stanford University, Stanford, California, USA. Davies, M.1., Cardiac Dept. St. George's Hospital, London, England. Dawson, J.R., Hillingdon Hospital, Uxbridge, Middlesex, England. Delatte, D., Cliniques Universitaires Saint-Luc, Brussels, Belgium. DeMaria, A.N., Section of Cardiovascular Medicine, School of Medicine,

Davis, California, USA. Distante, A., CNR Clinical Physiology Institute and University of Pisa, Pisa,

Italy. Durrer, D., Dept. of Cardiology, Wilhelmina Gasthuis, Amsterdam, The

N ethel'lands. Effert, S., Dept. of Internal Medicine I, Rheinisch-Westfalische Technische

Hochschule, Aachen, FRG. Erbel, R., Dept. of Internal Medicine I, Rheinisch-Westfalische Technische

Hochschule, Aachen, FRG. Eyll, Ch. van, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Ezekowitz, M.D., University of Oklahoma, Health Sciences Center,

Oklahoma City, Oklahoma, USA. Farjon, M., Dept of Cardiology, Fondation A. de Rothschild, Paris,

France. Fassbender, D., Gollwitzer Meier Institut, Bad Oeynhausen, FRG. Fehr, R., Central Research Units, F. Hoffmann-La Roche & Co, Basel,

Switzerland. Feigenbaum, H., Dept. of Medicine, University of Indiana, Indianapolis,

Indiana, USA. Fox, W.W., Div. of Neonatology, Children's Hospital of Philadelphia, School

of Medicine, Philadelphia, Pennsylvania, USA. Gewitz, M.H., Div. of Cardiology, Children's Hospital of Philadelphia,

School of Medicine, Philadelphia, Pennsylvania, USA. Gibson, D.G., Cardiac Dept. Brompton Hospital, London, England. Gleichmann, U., Gollwitzer Meier Institut, Bad Oeynhausen, FRG. Godman, M.1., Royal Hospital for Sick Children, Edinburgh, Scotland. Goldberg, S.1., University of Arizona, Tucson, Arizona, USA. Greene, H.L., Harborview Medical Center, University of Washington,

Seattle, Washington, USA. Gross, B.W., Harborview Medical Center, University of Washington, Seattle,

Washington, USA. Guerin, F., Hopital Cochin, Paris, France. Guichard, J.P., Dept. of Cardiology, Fondation A. de Rothschild, Paris,

France.

XVII

Guiney, T.E., Dept. of Cardiology, St. George's Hospital, London, England.

Gussenhoven, WJ., Interuniversity Cardiology Institute and Thoraxcenter, Erasmus University, Rotterdam, The Netherlands.

Hatle, L., Regional Hospital, Trondheim, Norway. Hanrath, P., Dept.· of Cardiology, University Hospital Hamburg, Hamburg,

FRG. Hansmann, M., Univ. Kinderklinik und Poliklinik Bonn, Bonn, FRG. Haskell, W.L., Stanford University, Stanford, California, USA. Hilger, H.H., Medical Clinic and Policlinic, Dept. of Cardiology, University

of Cologne, Cologne, FRG. Ho, P., Stanford University, Stanford, California, USA. Hoeks, A., Dept. of Biophysics, Biomedical Centre, University of Limburg,

Maastricht, The Netherlands. Hoenecke, H., University of Arizona, Tucson, Arizona, USA. Hombach, V., Medical Clinic and Policlinic, Dept. of Cardiology, University

of Cologne, Cologne, FRG. Hopman, lCW., Dept. of Pediatric Cardiology, University of Nijmegen,

Nijmegen, The Netherlands. Hunter, S., Regional Cardiothoracic Centre, Freeman Hospital, Newcastle

upon Tyne, England. Jackson, G., Cardiac Dept., King's College Hospital, London, England. Janko, CL., Harborview Medical Center, University of Washington, Seattle,

Washington, USA. Jansen, W.C, Medical Clinic and Policlinic, Dept. of Cardiology, University

of Cologne, Cologne, FRG. Jenni, R., Medical Policlinic, Dept. of Cardiology, University Hospital,

Zurich, Switzerland. Jewitt, D.E., Cardiac Dept. King's College Hospital, London, England. Kalmanson, D., Fondation A. de Rothschild, Paris, France. Kan, G., Dept. of Cardiology, Wilhelmina Gasthuis, Amsterdam, The

Netherlands. Kanaly, PJ., University of Oklahoma Health Sciences Center, Oklahoma

City, Oklahoma, USA. Kawabori, I., University of Washington, Seattle, Washington, USA. Krayenbuehl, H.P., Medical Policlinic, University Hospital Zurich,

University and ETH, Zurich, Switzerland. Kremer, P., Dept. of Cardiology, University Hospital Hamburg, Hamburg,

FRG. Lambertz, H., Dept. of Internal Medicine I, Rheinisch-Westfalische

Technische Hochschule, Aachen, FRG. Lancee, CT., Thoraxcenter, Erasmus University, Rotterdam, The Nether­

lands.

XVIII

Langenstein, B.A., Dept. of Cardiology, University Hospital Hamburg, Hamburg, FRG.

Leech, G.J., Cardiac Dept. of St. George's Hospital, London, England. Lutfalla, G., Hopital Cochin, Paris, France. Macartney, FJ., Dept. of Paediatric Cardiology, Hospital for Sick Children,

London, England. Magherini, A., Tuscan Heart and Chest Center, Florence, Italy. Martin, R.P., University of Virginia, Charlottesville, Virginia, USA. Maseri, A., CNR Clinical Physiology Institute and' University of Pisa, Pisa,

Italy. Mason, D.T., Section of Cardiovascular Medicine, School of Medicine,

Davis, California, USA. Matsumoto, M., Dept. of Cardiology, University Hospital Hamburg,

Hamburg, FRG. Mayor, Ch., Cardiac Center, University Hospital, Geneva, Switzerland. McCabe, D., University of Washington, Seattle, Washington, USA. McGhie, ]., Thoraxcenter, Erasmus University, Rotterdam, The

Netherlands. Minale, S., Dept. ofInternal Medicine I, Rheinisch-Westfalische Technische

Hochschule, Aachen, FRG. Meijboom, EJ., Div. of Cardiology and Neonatology, Children's Hospital of

Philadelphia, School of Medicine, Philadelphia, Pennsylvania, USA. Meyer, ]., Dept. of Internal Medicine I, Rheinisch-Westfalische Technische

Hochschule, Aachen, FRG. Medema, D.K., University of Washington, Seattle, Washington, USA. Meltzer, R.S., Thoraxcenter, Erasmus University, Rotterdam, The

Netherlands. Merier, G., Cardiac Center, University Hospital Geneva, Switzerland. Messmer, B.J., Dept. of Cardiovascular surgery, Rheinisch-Westfalische

Technische Hochschule, Aachen, FRG. Monaghan, MJ., Cardiac Dept. King's College Hospital, London, England. Moritz, W.E., University of Washington, Seattle, Washington, USA. Monsjou, L.K., Dept. of Cardiology, University of Leiden, Leiden, The

Netherlands. Niehues, B., Medical Clinic and Policlinic, Dept. of Cardiology, University

of Cologne, Cologne, FRG. Palombo, c., CNR Clinical Physiology Institute and University of Pisa, Pisa,

Italy. Parker, D.E., University of Oklahoma Health Sciences Center, Oklahoma

City, Oklahoma, USA. Parker, DJ., Cardiac Dept. St. George's Hospital, London, England. Pearlman, A.S., University of Washington, Seattle, Washington, USA. Peer, P.G.M., Dept. of Statistical Consultation, University of Nijmegen,

XIX

Nijmegen, The Netherlands. Popp, R.L., Stanford University, Stanford, California, USA. Ports, T.A., Cardiovascular Research Institute, University of California, San

Francisco, California, USA. Raphael, D., Cliniques Universitaires Saint-Luc, Brussels, Belgium. Razor, 1., Section of Cardiovascular Medicine, School of Medicine, Davis,

California, USA. Redel, D.A., Universitats Kinderklinik und Poliklinik Bonn, Bonn, FRG. Reneman, R.S., Dept. of Physiology, Biomedical Centre, University of

Limburg, Maastricht, The Netherlands. Roelandt, J.R.T.e., Thoraxcenter, Erasmus University, Rotterdam,

The Netherlands. Rovai, D., CNR Clinical Physiology Institute and University of Pisa, Pisa,

Italy. Ruissen, e., Dept. of Biophysics, Biomedical Centre, University of Limburg,

Maastricht, The Netherlands. Sahn, DJ., University of Arizona, Tucson, Arizona, USA. Sainte-Beuve, D., Dept. of Cardiology, Fondation A. de Rothschild, Paris,

France. Schicht, I., Dept. of Nephrology, University of Leiden, Leiden, The Nether­

lands. Schiller, N.B., Cardiovascular Research Institute, University of California,

San Francisco, California, USA. Scherer, E., Medical Clinic and Policlinic, Dept. of Cardiology, University of

Cologne, Cologne, FRG. Schweizer, P., Dept. of Internal Medicine I, Rheinisch-Westfalische

Technische Hochschule, Aachen, FRG. Serruys, P.W., Thoraxcenter, Erasmus University, Rotterdam, The

Netherlands. Silverman, N.H., Cardiovascular Research Institute, University of Califor­

nia, San Francisco, California, USA. Skjrerpe, T., Regional Hospital, Trondheim, Norway. Sinallhorn, J.F., Dept. of Paediatric Cardiology, Hospital for Sick Children,

London, England. Smeets, F., Dept. of Biophysics, Biomedical Centre, University of Limburg,

Maastricht, The Netherlands. Smith, E.O., University of Oklahoma Health Sciences Center, Oklahoma

City, Oklahoma, USA. Snider, A.R., Cardiovascular Research Institute, University of California,

San Francisco, California, USA. Stamm, R.B., University of Virginia, Charlottesville, Virginia, USA. Stevenson, 1.G., University of Washington, Seattle, Washington, USA. Stoelinga, G.B.A., Dept. of Pediatric Cardiology, University of Nijmegen,

xx

Nijmegen, The Netherlands. Speck, S.M., Harborview Medical Center, University of Washington, Seattle

Washington, USA. Sutherland, G.R, Regional Cardiothoracic Centre, Freeman Hospital,

Newcastle upon Tyne, England. Sutton, G.c., Hillingdon Hospital, Uxbridge, Middlesex, England. Taylor, G., University of Virginia, Charlottesville, Virginia, USA. Tickner, E.G., Ultra Med. Inc. (formerly Rasor Associates Inc.), Sunnyvale,

California, USA. Trieb, G., Gollwitzer Meier Institut, Bad Oeynhausen, FRG. Tommasini, G., Dept. of Paediatric Cardiology, Hospital for Sick Children,

London, England. Toussaint, M., Hopital Cochin, Paris, France. Tucker, C.R., Stanford University, Stanford, California, USA. Turina, l, Medical Policlinic, University Hospital ZUrich, University and

ETH, ZUrich, Switzerland. Valdes-Cruz, L.M., University of Arizona, Tucson, Arizona, USA. Verbeek, P.W., University of Technology Delft, Delft, The Netherlands. Vernejoul, Fl. de, Hopital Cochin, Paris, France. Veyrat, c., Dept. of Cardiology, Fondation A. de Rothschild, Paris,

France. Vieli, A., Institute for Biomedical Engineering, University and ETH, ZUrich,

Switzerland. Visser, c.A., Dept. of Cardiology, Wilhelmina Gasthuis, Amsterdam, The

Netherlands. Voogd,'PJ., Dept. of Cardiology, University of Leiden, Leiden, The

Netherlands. Vosters,' R, Dept. of Obstetrics and Gynaecology, Erasmus University,

Rotterdam, The Netherlands. Watson, D., University of Virginia, Charlottesville, Virginia, USA. Weiss, J.L., Heart Station, The Johns Hopkins Hospital, Baltimore, Mary­

land, USA. Wells, P.N.T., Bristol General Hospital, Bristol, England. Werner, lA., Harborview Medical Center, University of Washington,

Seattle, Washington, USA. Wieken, L.R van der, Dept. of Cardiology, Wilhelmina Gasthuis,

Amsterdam, The Netherlands. Wilson, D.A., University of Oklahoma Health Sciences Center, Oklahoma

City, Oklahoma, USA. Wladimiroff, J.W., Dept. of Obstetrics and Gynaecology, Erasmus Universi­

ty, Rotterdam, The Netherlands. Wood, D.C., Div. of Cardiology, The Children's Hospital of Philadelphia,

School of Medicine, Philadelphia, Pennsylvania, USA Wood, P.D., Stanford University, Stanford, California, USA.